BluePreferred ValuePlan

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Plans Starting At

$103 Single

$300 Family

$121 Single

$353 Family

$126 Single

$367 Family

$131 Single

$382 Family

$139 Single

$405 Family

$148 Single

$431 Family

$156 Single

$453 Family

$164 Single

$477 Family

$173 Single

$505 Family

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Coverage Created Just For You

Plans for Singles, Couples and Families

You want protection against hospital and doctor expenses, but don’t need coverage for certain types of medical care. Choose from single or family plans – coverage does not include pregnancy and maternity services or inpatient treatment for mental illness or substance abuse.

View plan option by deductible:

  In Network
Single/Family		 Out of Network
Single/Family
Deductible
(Calendar year)		 $5,000/$10,000 $10,000/$20,000
Coinsurance Max
(Calendar year)		 $2,500/$5,000 $6,000/$12,000
Total out-of-pocket
(Deductible + coinsurance max; no copays)		 $7,500/$15,000 $16,000/$32,000
Coinsurance % for most covered services 20% 40%
Diagnostic office visit copay* N/A
Maternity care/pregnancy services No Coverage
Inpatient mental illness/substance abuse treatment No Coverage
Outpatient mental illness/substance abuse treatment 30% 60%
Prescription Drug Coverage Subject to deductible and coinsurance
Mental illness/substance abuse treatment $10,000 per covered person
Total contract benefit maximum $10 million per covered person
  In Network
Single/Family		 Out of Network
Single/Family
Deductible
(Calendar year)		 $3,500/$7,000 $7,000/$14,000
Coinsurance Max
(Calendar year)		 $2,500/$5,000 $6,000/$12,000
Total out-of-pocket
(Deductible + coinsurance max; no copays)		 $6,000/$12,000 $13,000/$26,000
Coinsurance % for most covered services 20% 40%
Diagnostic office visit copay* N/A
Maternity care/pregnancy services No Coverage
Inpatient mental illness/substance abuse treatment No Coverage
Outpatient mental illness/substance abuse treatment 30% 60%
Prescription Drug Coverage $8 generic
30% ($35 minimum/$60 maximum) formulary brand name
50% ($60 minimum/$100 maximum) non-formulary brand name
Mental illness/substance abuse treatment $10,000 per covered person
Total contract benefit maximum $10 million per covered person
  In Network
Single/Family		 Out of Network
Single/Family
Deductible
(Calendar year)		 $3,000/$6,000 $6,000/$12,000
Coinsurance Max
(Calendar year)		 $2,500/$5,000 $6,000/$12,000
Total out-of-pocket
(Deductible + coinsurance max; no copays)		 $5,500/$11,000 $12,000/$24,000
Coinsurance % for most covered services 20% 40%
Diagnostic office visit copay* $30 N/A
Maternity care/pregnancy services No Coverage
Inpatient mental illness/substance abuse treatment No Coverage
Outpatient mental illness/substance abuse treatment 30% 60%
Prescription Drug Coverage $8 generic
30% ($35 minimum/$60 maximum) formulary brand name
50% ($60 minimum/$100 maximum) non-formulary brand name
Mental illness/substance abuse treatment $10,000 per covered person
Total contract benefit maximum $10 million per covered person
  In Network
Single/Family		 Out of Network
Single/Family
Deductible
(Calendar year)		 $2,500/$5,000 $5,000/$10,000
Coinsurance Max
(Calendar year)		 $2,500/$5,000 $6,000/$12,000
Total out-of-pocket
(Deductible + coinsurance max; no copays)		 $4,500/$9,000 $10,000/$20,000
Coinsurance % for most covered services 20% 40%
Diagnostic office visit copay* N/A
Maternity care/pregnancy services No Coverage
Inpatient mental illness/substance abuse treatment No Coverage
Outpatient mental illness/substance abuse treatment 30% 60%
Prescription Drug Coverage $8 generic
30% ($35 minimum/$60 maximum) formulary brand name
50% ($60 minimum/$100 maximum) non-formulary brand name
Mental illness/substance abuse treatment $10,000 per covered person
Total contract benefit maximum $10 million per covered person
  In Network
Single/Family		 Out of Network
Single/Family
Deductible
(Calendar year)		 $2,000/$4,000 $4,000/$8,000
Coinsurance Max
(Calendar year)		 $2,500/$5,000 $6,000/$12,000
Total out-of-pocket
(Deductible + coinsurance max; no copays)		 $4,500/$9,000 $10,000/$20,000
Coinsurance % for most covered services 20% 40%
Diagnostic office visit copay* N/A
Maternity care/pregnancy services No Coverage
Inpatient mental illness/substance abuse treatment No Coverage
Outpatient mental illness/substance abuse treatment 30% 60%
Prescription Drug Coverage $8 generic
30% ($35 minimum/$60 maximum) formulary brand name
50% ($60 minimum/$100 maximum) non-formulary brand name
Mental illness/substance abuse treatment $10,000 per covered person
Total contract benefit maximum $10 million per covered person
  In Network
Single/Family		 Out of Network
Single/Family
Deductible
(Calendar year)		 $1,500/$3,000 $3,000/$6,000
Coinsurance Max
(Calendar year)		 $2,500/$5,000 $6,000/$12,000
Total out-of-pocket
(Deductible + coinsurance max; no copays)		 $4,000/$8,000 $9,000/$18,000
Coinsurance % for most covered services 20% 40%
Diagnostic office visit copay* N/A
Maternity care/pregnancy services No Coverage
Inpatient mental illness/substance abuse treatment No Coverage
Outpatient mental illness/substance abuse treatment 30% 60%
Prescription Drug Coverage $8 generic
30% ($35 minimum/$60 maximum) formulary brand name
50% ($60 minimum/$100 maximum) non-formulary brand name
Mental illness/substance abuse treatment $10,000 per covered person
Total contract benefit maximum $10 million per covered person
  In Network
Single/Family		 Out of Network
Single/Family
Deductible
(Calendar year)		 $1,250/$2,500 $2,500/$5,000
Coinsurance Max
(Calendar year)		 $2,000/$4,000 $5,000/$10,000
Total out-of-pocket
(Deductible + coinsurance max; no copays)		 $3,250/$6,500 $7,500/$15,000
Coinsurance % for most covered services 20% 40%
Diagnostic office visit copay* N/A
Maternity care/pregnancy services No Coverage
Inpatient mental illness/substance abuse treatment No Coverage
Outpatient mental illness/substance abuse treatment 30% 60%
Prescription Drug Coverage $8 generic
30% ($35 minimum/$60 maximum) formulary brand name
50% ($60 minimum/$100 maximum) non-formulary brand name
Mental illness/substance abuse treatment $10,000 per covered person
Total contract benefit maximum $10 million per covered person
  In Network
Single/Family		 Out of Network
Single/Family
Deductible
(Calendar year)		 $1,000/$2,000 $2,000/$4,000
Coinsurance Max
(Calendar year)		 $2,000/$4,000 $5,000/$10,000
Total out-of-pocket
(Deductible + coinsurance max; no copays)		 $3,000/$6,000 $7,000/$14,000
Coinsurance % for most covered services 20% 40%
Diagnostic office visit copay* $30 N/A
Maternity care/pregnancy services No Coverage
Inpatient mental illness/substance abuse treatment No Coverage
Outpatient mental illness/substance abuse treatment 30% 60%
Prescription Drug Coverage $8 generic
30% ($35 minimum/$60 maximum) formulary brand name
50% ($60 minimum/$100 maximum) non-formulary brand name
Mental illness/substance abuse treatment $10,000 per covered person
Total contract benefit maximum $10 million per covered person
  In Network
Single/Family		 Out of Network
Single/Family
Deductible
(Calendar year)		 $750/$1,500 $1,500/$3,000
Coinsurance Max
(Calendar year)		 $1,500/$3,000 $4,000/$8,000
Total out-of-pocket
(Deductible + coinsurance max; no copays)		 $2,250/$4,500 $5,500/$11,000
Coinsurance % for most covered services 20% 40%
Diagnostic office visit copay* N/A
Maternity care/pregnancy services No Coverage
Inpatient mental illness/substance abuse treatment No Coverage
Outpatient mental illness/substance abuse treatment 30% 60%
Prescription Drug Coverage $8 generic
30% ($35 minimum/$60 maximum) formulary brand name
50% ($60 minimum/$100 maximum) non-formulary brand name
Mental illness/substance abuse treatment $10,000 per covered person
Total contract benefit maximum $10 million per covered person
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* When you use a PPO doctor, you pay only a $30 copay for a diagnostic (non-routine) office visit exam charge. The copay does not apply toward the calendar year coinsurance maximum.

This coverage does not provide benefits for inpatient treatment of mental illness and/or substance abuse treatment, maternity care, and/or pregnancy services.

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